CN106163455A - Methods and devices for spinal correction - Google Patents

Methods and devices for spinal correction Download PDF

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Publication number
CN106163455A
CN106163455A CN 201580018230 CN201580018230A CN106163455A CN 106163455 A CN106163455 A CN 106163455A CN 201580018230 CN201580018230 CN 201580018230 CN 201580018230 A CN201580018230 A CN 201580018230A CN 106163455 A CN106163455 A CN 106163455A
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portion
system
disc
load
information
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CN 201580018230
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Chinese (zh)
Inventor
M.J.奥内尔
R.罗姆利
J.R.豪金斯
C.拉姆齐
Z.布特瓦拉
J.迪皮特罗
J.格里芬
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德普伊新特斯产品公司
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    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657Measuring instruments used for implanting artificial joints
    • A61F2002/4666Measuring instruments used for implanting artificial joints for measuring force, pressure or mechanical tension

Abstract

An expandable trial can include an inferior portion, a superior portion, and a middle expanding portion as well as load cells for monitoring the load on the trial. The trial may also include recesses on its lateral sides to provide spacing to accommodate a disc removal tool so tissue can be cleared monitoring load. In addition, neural foramen spacing can be monitoring to provide information about how much neural release has been achieved as the disc is cleaned and the spine is positioned and repositioned.

Description

用于脊柱矫形的方法和装置 A method and apparatus for spinal orthotic

技术领域 FIELD

[0001]本公开涉及脊柱矫形方法和包括可扩展试验植入物的脊柱矫形系统,以及用于监测所实现的神经间隙量并且任选地监测椎间盘空间牵张量以及椎骨终板上的力的技术。 [0001] The present disclosure relates to a method and orthopedic spinal scoliosis correction system comprising an expandable trial implant, and a nerve monitoring the amount of clearance achieved and optionally monitoring the amount of distraction of the disc space and vertebral endplates force technology.

背景技术 Background technique

[0002]人体脊柱是通过被称为“椎间盘”的柔性盘分隔的一系列骨椎体。 [0002] by the human spine is a series of vertebral body is known as "disc" flexible disk separated. 椎间盘包含可压缩的柔性胶状中心,称为髓核。 The disc comprises a flexible compressible gum center, called the nucleus pulposus. 这种柔性允许脊柱弯曲和扭曲。 This flexibility allows bending and twisting of the spine. 纤维环是一种更坚韧的纤维材料,它围绕并包含髓核,否则髓核可能被挤出到人体的其他部分中。 Annulus is a more tough fibrous material, which surrounds and contains the nucleus, the nucleus may be extruded or to other parts of the human body.

[0003]人体骨骼为人体提供架构性结构。 [0003] human skeleton provides structural framework for the human body. 人体脊柱不仅提供用于支撑人体重量的机械结构,而且还为神经系统的“经线”提供通道。 Human spine only provides a mechanical structural support for the body weight, but also for the nervous system "warp" provides channel. 脊柱为神经从脑到人体其他部分的行进提供间隙。 Spine provide clearance from the brain to other parts of the body travels to the nerve. 大部分这种间隙是包含并保护脊髓的椎管。 Much of this gap is to contain and protect the spinal cord. 脊柱还在脊柱的每个层级上限定用于神经根从脊髓分支并且行进到人体的其他部分的间隙。 On each level of the spinal column is also defined for spinal nerve roots and spinal cord branch travels to the gap of the other parts of the body. 椎体之间的椎间盘在椎体之间提供适当的间隙量来为这些神经根留出空间方面起着关键作用。 Disc between the vertebrae provide an appropriate amount of clearance between the vertebrae to allow space plays a key role in the nerve root. 如果椎间盘开始从其正常高度塌缩,神经根可能受到压迫并导致疼痛。 If the disc starts to collapse from its normal height, compression of nerve roots and cause pain may be.

[0004]椎间盘还有助于提供椎体的对齐,使椎管保持为用于脊髓的相对平滑的通道。 [0004] The disc also help provide alignment of the vertebral body, spinal canal remains relatively smooth passage for the spinal cord. 如果椎间盘变得不对齐,椎管可能脱开并且在多个部分中变得极窄。 If the disc become misaligned, and the spinal canal may become disengaged in a plurality of portions extremely narrow. 如果它变得过窄,脊髓可能受到压迫并导致疼痛。 If it becomes too narrow, spinal cord may cause pain and oppression. 椎骨脱离就是可能影响椎管中的间隙的一种情况的示例。 Spondylolysis example is a situation that may affect the clearance of the spinal canal. 在椎骨脱离中,一个椎体相对于另一个椎体向前滑动。 In spondylolysis in a vertebral body to slide forward relative to the other vertebrae. 这可以导致椎管变窄和脊髓压迫。 This can lead to narrowing of the spinal canal and spinal cord compression.

[0005]其他脊柱病症也可以导致神经压迫。 [0005] other spinal disorders can also cause nerve compression. 例如,椎间盘退变性疾病(DDD)可以导致椎间盘突出。 For example, degenerative disc disease (DDD) can lead to disc. 在髓核的一部分从椎间盘空间挤出时,会发生椎间盘突出。 When a portion of the nucleus pulposus is extruded through the disc space, disc herniation occurs. 这种挤出可能冲击到神经并导致疼痛。 Such extrusion may impinge the nerve and cause pain. 另外,髓核的过多挤出可能导致椎间盘高度的减小,并且导致神经根可用的间隙变窄。 Further, excessive extruded nucleus pulposus may result in a reduction of the disc height, and causes nerve root gap is narrowed available.

[0006] —种管理这些问题的常用方法是移除有问题的椎间盘并将其替换成恢复椎间盘高度并且允许骨穿过其生长的装置。 [0006] - management of these kinds of problems common method is to remove the problematic disc and replace it restore disc height and allows for bone growth through the device. 这就导致两个或更多个相邻椎骨的融合。 This leads to fusion of two or more adjacent vertebrae. 该过程中使用的装置通常被称为“融合装置”或“融合笼”。 The apparatus used in the process commonly referred to as "fusion device" or "fusion cage."

[0007]在融合过程中,外科医生首先触及椎间盘空间。 [0007] In the fusion process, the surgeon first touched the disc space. 接下来,外科医生清理掉椎间盘空间的一部分以为融合装置(或笼)腾出空间。 Next, clean out the part of the surgeon thought fusion device (or cage) to make room for the disc space. 外科医生可通过使用试验植入物并经由触觉和视觉评估“测试”其贴合性(通常通过荧光镜透视检查)来确定适当尺寸的融合笼。 The surgeon may determine the appropriate size of the fusion cage implant by using the test and via tactile and visual assessment of "test" which fit (typically fluoroscopically fluoroscopy). 也可使用神经监测来确认神经结构未受到显著伤害或损坏。 Nerve monitoring can also be used to confirm the structure is not subjected to significant nerve injury or damage. 例如,可使用神经监测来测试神经的反应和延迟,这可以给出对神经健康程度的指示。 For example, a nerve monitoring, and to test the nerves of delay, which may give an indication of the health of the nerve. 然而,神经监测不会确定过程是否已构建了足够的“空间”(称为神经释放)来缓解神经上的压迫。 However, nerve monitoring to determine whether the process has not built enough "space" (called nerve release) to ease the oppression of nerves.

发明内容 SUMMARY

[0008] —种可扩展试验物可包括下部部分、上部部分、和中间扩展部分以及用于监测试验物上的负荷的负荷传感器。 [0008] - Test Species expandable composition may include a lower portion, an upper portion, and an intermediate extension section and a load sensor for monitoring load on a test object. 试验物还可在其横向侧上包括凹陷部以提供容纳椎间盘移除工具的间隙,以便可以在监测负荷的同时清理组织。 Tests may also include a recess portion on a lateral side thereof to provide clearance removal tool receiving disc, so that tissue can be cleaned at the same time monitoring the load. 此外,可监测神经孔间隙以在椎间盘被清理并且脊柱被定位和重新定位时提供有关已实现多少神经释放的信息。 In addition, the gap can be monitored neural foramen to clean up when the disc and spinal column are positioned and repositioned to provide information on how much nerve release has been achieved.

附图说明 BRIEF DESCRIPTION

[0009]图1a为用于使用可扩展试验植入物进行脊柱矫形并监测所实现的神经间隙量的方法的示例性实施方案的流程图。 [0009] The flowchart of FIG. 1a is an exemplary embodiment using expandable trial implant for orthopedic and spinal nerve gap amount monitoring method implemented.

[0010]图1b为用于脊柱矫形的可与图1a的方法结合使用的系统的示例性实施方案的系统示意图。 [0010] The system diagram of an exemplary embodiment of a method for spinal 1b orthopedic use may be in combination with the system of FIG. 1a, FIG.

[0011]图2a示出了可与图1a的方法结合使用的图像引导式外科系统的示例性实施方案。 [0011] Figure 2a illustrates an exemplary embodiment of an image guided surgical system may be used in conjunction with the method of FIG. 1a.

[0012]图2b示出了可与图1a的方法结合使用的肌电图跟踪系统(mylogram trackingsystem)的示例性实施方案。 [0012] FIG 2b shows the method of use in conjunction with FIG. 1a EMG tracking system (mylogram trackingsystem) of the exemplary embodiment.

[0013]图2c示出了可与图1a的方法结合使用的直接可视化系统的示例性实施方案。 [0013] Figure 2c illustrates an exemplary embodiment may be combined with the use of the method of FIG. 1a direct visualization system.

[0014]图2d示出了可与图1a的方法结合使用的超声检测系统的示例性实施方案。 [0014] Figure 2d shows an exemplary embodiment may be combined with ultrasonic detection system for use with the method of FIG. 1a.

[0015]图2e示出了可与图1a的方法结合使用的直接可视化系统的示例性实施方案。 [0015] Figure 2e shows an exemplary embodiment using the exemplary embodiment may be combined with the method of FIG. 1a direct visualization system.

[0016]图2f示出了可与图1a的方法结合使用的基于染料的肌电图跟踪系统的示例性实施方案。 [0016] Figure 2f illustrates an exemplary embodiment of the tracking system based on the EMG dye may be used in combination with the method of FIG. 1a.

[0017]图3a和图3b示出了可与图1a的方法结合使用的可扩展试验植入物的示例性实施方案。 [0017] Figures 3a and 3b show an exemplary embodiment may be used in conjunction with the method of FIG. 1a expandable trial implant.

[0018]图4a、4b和4c示出了提供来自可扩展试验植入物的负荷信息的顶视图的视觉显示系统的示例性实施方案,该可扩展试验植入物可与图1a的方法结合使用。 [0018] Figures 4a, 4b and 4c show an exemplary embodiment provides a top view of the expandable implant trial load information from the visual display system, the expandable implant trial may be combined with the method of FIG. 1a use.

[0019]图5a至图5h示出了可与图1a的方法结合使用的可扩展试验植入物的另一示例性实施方案的示例性实施方案。 [0019] Figures 5a to 5h illustrate an exemplary embodiment of another exemplary embodiment may be used in conjunction with the method of FIG. 1a expandable trial implant.

[0020]图6a至图6h示出了可与图1a的方法结合使用的可扩展试验植入物的另一示例性实施方案。 [0020] Figures 6a to 6h illustrate another exemplary embodiment of the method may be used in conjunction with Fig. 1a expandable trial implant.

具体实施方式 detailed description

[0021]图1a为用于使用可扩展试验植入物进行脊柱矫形并且包括监测所实现的神经间隙量的方法10的示例性实施方案的流程图。 [0021] Figure 1a is a trial for using expandable spinal implant for orthopedic and neurological gap amount flowchart implemented method for monitoring the exemplary embodiment 10 comprises. 虽然示出了各个方法步骤,但不是每个步骤都必须执行,例如在一些情况下,可以不确定术中基线。 Although an individual method steps, but not every step must be performed, for example, in some cases, surgery may not determine the baseline. 其他步骤也可省略。 Other steps may also be omitted.

[0022]脊柱矫形方法10可用图1b所示的脊柱矫形系统50来实施。 [0022] The spinal orthopedic spinal orthopedic system shown in FIG. 1b 50 Method 10 may be implemented. 如图1b所示,脊柱矫形系统50包括神经释放系统70 ο神经释放系统70包括神经间隙监测系统72,该神经间隙监测系统确定表示所实现的神经间隙量的信息。 1b, orthopedic spinal nervous system 50 includes a delivery system 70 comprises a 70 o nervous system release 72, the gap amount information neural monitoring system determines the nerve gap represents the gap implemented neural monitoring system. 神经间隙监测系统72可以各种实施方案来实施,这些实施方案诸如将结合图2a至图2f所讨论的实施方案。 Nervous gap monitoring system 72 may be implemented in various embodiments, these embodiments, such as embodiments in conjunction with FIGS. 2a to 2f discussed. 神经释放系统70还包括显示装置74和数据存储器76。 Nervous release system 70 further comprises a display device 74 and a data memory 76. 神经释放系统70还可与聚合并评估医疗数据的数据聚合系统80通信。 Nervous delivery system 70 may also communicate data with the polymerization polymerization system and evaluate medical data 80. 数据聚合系统80可为各自以引用方式全文并入本文的以下专利申请中的任一个中所述的系统:2012年9月17 日提交的名称为“Systems and Methods for Surgical Planning,Support,and Review”的美国专利申请序列号61/702,073;2012年12月19日提交的名称为uSvstems and Methods for Surgical Planning,Support,and Review” 的美国专利申请序列号61/739,514 ;以及2013年3月14日提交的名称为“Svstems and Methods forSurgical and Intervent1nal Planning,Support,Postoperative Follow-Up,andFunct1nal Recovery Tracking”的美国专利申请序列号13/803,763。数据聚合系统80可存储来自神经间隙监测系统72和神经释放系统70的数据以及其他术后数据,并使用数据的组合来预测具体患者的未来手术的融合和/或疼痛缓解的成功可能性。对成功可能性的预测可基于对其他患者的手术的过往效果并且基于与该具体患者有关的信息。数据聚合系统80可使 Data aggregation system 80 may be any according to each one incorporated herein by reference in the following patent applications in the system: the name of September 17, 2012 entitled "Systems and Methods for Surgical Planning, Support, and Review "US Patent application serial No. 61 / 702,073; the name of December 19, 2012 filed uSvstems and Methods for Surgical Planning, Support, and Review" of US Patent application serial No. 61 / 739,514; and in 2013 Title March 14 filed "Svstems and Methods forSurgical and Intervent1nal Planning, Support, Postoperative Follow-Up, andFunct1nal Recovery Tracking" U.S. Patent application serial No. 13 / 803,763. data aggregation system 80 may store the monitoring system from the nerve gap 72 and data, and other data after the release of the nervous system 70, and to predict future fusion surgery patient-specific and / or the likelihood of success for pain relief using the combined data to predict the likelihood of success of surgery can be based on other patients based on past results and related to the particular patient information system 80 allows data aggregator 本文所述的任一种技术和算法来进行此类预测。 The technique described herein and any of these algorithms to predict.

[0023]脊柱矫形系统50包括可以下文进一步讨论的各种实施方案来实施的术前计划系统60。 [0023] scoliosis correction system 50 includes a planning system can be below 60 preoperative various embodiments discussed further embodiment to be implemented. 脊柱矫形系统50还包括负荷与接触系统65,该负荷与接触系统在可扩展试验植入物的各个部分处确定该植入物上的负荷并且还确定该试验植入物的已接触椎体的终板的部分。 Scoliosis correction system 50 further comprises a contact system with a load 65, the load and the system determines the contact load on the implant at various portions of the expandable trial implant has been determined and further contacting the vertebral body implant trial end plate portion. 虽然示出了各种部件,但脊柱矫形系统50不是必须包括每个部件/系统。 Although a variety of components, but not necessarily, scoliosis correction system 50 comprises for each component / system. 此外,虽然脊柱矫形系统50被示出为包括独立的物理部件,但系统50可以一个物理部件来实施或者可以与所示不同的方式分布在各种部件之间。 Further, although the spine orthopedic system 50 is shown as comprising a separate physical component, but a physical component of the system 50 may be implemented in different ways, or may be distributed among the various components shown in FIG.

[0024]回到图1a的方法10,如步骤100所示,术前计划使用术前计划系统60来执行。 [0024] Returning to FIG. 1a is a method 10, as shown in step 100, preoperative planning is performed using the preoperative planning system 60. 术前计划系统60可包括成像系统(例如,磁共振成像(MRI)系统、X射线系统、荧光镜透视检查系统、计算断层摄影(CT)系统等)以估计现有(术前)神经间隙和现有神经压迫的量以及可扩展植入物所实现的椎间盘空间量。 Preoperative planning system 60 may include an imaging system (e.g., magnetic resonance imaging (MRI) system, X-ray systems, fluoroscopy systems, computed tomography (CT) system, etc.) prior to estimating (preoperative) nerve gaps and nerve crush amount and the amount of the conventional disc space expandable implant achieved. 该信息可传送到神经释放系统70以用于确定计划脊柱矫形量和计划神经释放量。 This information can be transmitted to the nervous system to release 70 for determining the amount of planned orthopedic and spinal nerve planned release. 计划脊柱矫形量和计划神经释放量可基于数据聚合系统80中的数据聚合,该数据聚合包括脊柱手术的历史数据以及脊柱手术的疼痛缓解效果。 Schedule planning orthopedic spinal nerve release an amount of data aggregation may be based on the polymerization system data 80, the history data includes data aggregation pain, spinal surgery and spinal surgery to alleviate the effect.

[0025]现有脊柱异常量和计划脊柱矫形量可使用各种参数来描述。 [0025] The amount of the existing exception spinal scoliosis correction amount and the program can be used to describe the various parameters. 术前计划系统60可计算现有术前椎间盘空间高度(其可包括椎间盘各个部分处的椎间盘空间高度,所述各个部分例如为后部、前部、侧部、中心等)。 Preoperative planning system 60 may calculate the disc space height prior preoperative (which may include a portion of the height of each disc at the disc space, each of said rear portion, for example, front, side, center, etc.). 术前计划系统60还可计算现有术前椎间盘空间角度(其可包括上终板沿各平面的角度、下终板沿各平面的角度、上终板与下终板之间的角度,等等)。 Preoperative planning system 60 may also calculate the disc space prior preoperative angle (which may include an upper endplate in the angle of each plane, the angle of each end plate in the plane, the angle between the upper endplate and the lower endplate, and the like Wait). 该角度可以表示脊柱前凸、脊柱后凸、矢状面平衡和冠状位平衡的现有术前量。 The angle may represent lordosis, kyphosis, sagittal and coronal balance balance prior preoperative amount. 现有术前参数可基于来自CT、MRI或其他非入侵技术的图像来计算。 Preoperative prior parameter may be calculated based image from a CT, MRI or other non-invasive techniques.

[0026]神经释放系统70(或者,术前计划系统60或数据聚合系统80)可计算计划术后椎间盘空间高度,或高度的变化,以及计划术后椎间盘空间角度,或角度的变化(以及其他参数,诸如一个椎体相对于另一个椎体的为了矫正椎骨脱离而进行的所需或计划矢状面和/或前后部调整)。 [0026] nervous system release 70 (or, preoperative planning system 60 or data aggregation system 80) may be calculated after the program disc space height, or height changes, the angle of the disc space and after programs, or changes in the angle (as well as other parameters, such as a vertebral body relative to the desired program or sagittal and / or adjustment of the front and rear portions in order to correct for spondylolysis and another vertebral body). 计划术前参数可基于来自CT、MRI等的图像以及基于先前脊柱手术的经验数据来计算。 Before planned surgery and parameters can be calculated based on images from CT, MRI and other data based on the experience of previous spinal surgery. 经验数据可包括术前的和术后的椎间盘空间高度和角度(以及其他参数),还包括表示先前手术的效果的数据。 Empirical data can include disc space height and angle of preoperative and postoperative (and other parameters), also includes data representing the effect of a previous surgery. 所述效果可包括术后疼痛数据、融合数据等。 The effects may include postoperative pain data, data fusion and the like. 所述计算可以通过术前计划系统60在利用或不利用来自数据聚合系统80的信息的情况下执行。 The calculation may be performed in the case 60 with or without information from the data system 80 through a polymerization preoperative planning system.

[0027]除计算计划或所需术后几何尺寸之外,神经释放系统70(或者,术前计划系统60或数据聚合系统80)可计算所需或计划术后神经释放量。 [0027] In addition to calculating the required post plan or geometry, nervous system release 70 (or, preoperative planning system 60 or data aggregation system 80) may calculate a desired or planned release neural surgery. 取决于术中要使用的神经释放监测系统的类型,计划神经释放量可呈现多种形式。 Type of release of nerve monitoring system to be used depends on the surgery, it plans to release nerve can take many forms. 计划术后神经释放量可基于来自CT、MRI等的图像来计算,并且可以基于先前脊柱手术的经验数据,例如使用来自数据聚合系统80的信息。 After release neural plan based on the image may be computed from a CT, MRI or the like, and may be based on empirical data of previous spinal surgery, for example, using information from the data aggregation system 80. 经验数据可包括术前和术后的椎间盘空间高度和角度以及对齐,还包括表示先前手术的效果的数据。 May include empirical data before and after the disc space height and angle, and alignment, further comprising data representing a previous surgical effect. 所述效果可包括术后疼痛指示、融合指示等。 The effects may include postoperative pain indication, other fusion indication.

[0028]如步骤110所示,由神经释放系统70获取和接收术中基线测量。 [0028] As shown in step 110, acquired by the delivery system 70 and the receiving nerve surgery baseline measurements. 例如,在患者被定位之后,外科医生可获得实际神经间隙(例如,实际神经孔尺寸,或者表示神经孔尺寸的信息,诸如基于直接可视化的压力、尺寸计算等)的基线。 For example, after a patient is positioned, the surgeon and at the actual nerve gap (e.g., nerve actual pore size, pore size or neural representation information, such as based on direct visualization of pressure, sizing, etc.) baseline. 这可使用神经间隙监测系统72来实现。 This can be accomplished using the neural gap 72 monitoring system. 由于该信息是术中确定的,因此它可能比步骤100中获得的在术前确定的信息更准确。 Since the information is determined in operation, so it may preoperatively determine the information obtained in step 100 is more than accurate. 神经间隙监测系统72还可确定实际神经压迫(例如,神经的尺寸减小、神经压迫下的流体压力差、或者表示实际神经压迫的其他信息)。 Monitoring system 72 may also nervous gap determine the actual nerve compression (e.g., to reduce the size of the nerve, the fluid pressure difference nerve compression, nerve compression, or other information about the actual representation). 神经释放系统70使用术中基线测量来确定更新的计划神经释放量。 The nervous system to release 70 using surgery baseline measurements to determine the planned release of nerve updated.

[0029]神经释放系统70可基于神经间隙监测系统72提供的术中信息并且可能地基于存储在例如数据聚合系统80中的历史和/或经验信息,使用各种算法来计算孔间隙。 [0029] System 70 may be based on neural surgery release neural monitoring system 72 provides a gap in the information and possibly based on data stored in the polymerization system, for example, history and / or experience in the information 80, using various algorithms to calculate the clearance hole. 神经释放系统70可使用孔高度测量和孔宽度测量来计算孔间隙。 Nervous system release holes 70 can be calculated using the clearance hole aperture width measurement and a height measurement. 神经释放系统70可基于测得的高度和宽度来计算孔面积。 Nervous system release hole 70 may calculate an area based on the measured height and width. 神经释放系统70还可基于可被平均化并且可提供更准确的孔面积确定的多个测得高度和宽度来计算孔面积。 Nervous delivery system 70 may also be averaged based and may provide a more accurate determination of a plurality of hole area was measured to calculate the height and width of aperture area. 神经释放系统70还可基于测得的高度和宽度以及测得的深度来计算孔体积。 Nervous system release hole 70 may also be calculated based on the measured height and width and a depth measured volume. 神经释放系统70还可基于可被平均化并且可提供更准确的孔体积测定的多个测得高度、宽度和深度来计算孔面积。 Nervous delivery system 70 may also be averaged based and may provide a more accurate measurement of pore volume measured by a plurality of height, width and depth of the hole area is calculated. 另选地,仅将孔高度用作神经释放的表不O Alternatively, only the height of the wells is not used as the table release neural O

[0030]神经释放系统70可基于从成像系统接收的几何尺寸信息,例如借助于超声检测系统240 (下文更详细地描述),来计算孔面积和/或体积,或者所述测量可基于不提供与孔面积和/或体积有关的几何尺寸信息的测量来推断。 [0030] System 70 may be based on neural release geometry information received from the imaging system, for example by means of ultrasonic testing system 240 (described in more detail below), to calculate the pore area and / or volume, or may be based on the measurement is not available geometric measurement information related to aperture area and / or volume be inferred about. 例如,神经释放系统70可从压力系统220(下文更详细地描述)接收压力信息。 For example, system 70 may release neural (described in more detail below) from the pressure system 220 receives pressure information. 神经释放系统70可基于将压力与孔面积或体积相关联的历史和/或经验信息来计算或估计孔面积或体积。 Nervous delivery system 70 may be based on the area or volume of pores with pore pressure history associated area or volume, and / or experience information calculated or estimated. 该信息可存储在例如数据聚合系统80中。 This information may be stored in the system 80, for example, the data aggregation. 神经释放系统70可以仅使用可表示孔几何尺寸信息的压力信息,而不是将压力信息转换成面积和/或体积信息。 Nervous delivery system 70 may use pore pressure information may indicate only the geometry information, instead of converting the information into the pressure area and / or volume information. 如下文更详细地讨论,神经释放系统70可将来自压力系统220的测得压力与压力阈值进行比较,而不是转换成孔面积并将该孔面积与面积阈值进行比较。 As discussed in more detail, nervous system release 70 the measured pressure with the pressure threshold pressure from the system 220 can be compared, rather than converting to the area of ​​the hole and the hole area compared with the area threshold.

[0031]神经释放系统70还可将术前和术中信息包括到对孔面积和/或孔体积或者对表示孔面积和/或孔体积的其他信息(例如,压力)的计算中。 [0031] nervous system 70 may also release the preoperative and intraoperative information into aperture area and / or pore volume or pore area indicating the calculated and / or pore volume additional information (e.g., pressure) in the pair. 例如,神经释放系统70可基于术中信息来调节术前测量。 For example, delivery system 70 may be based on neural surgery preoperative information to adjust the measurement. 这种调节可为对术前信息的比率调节或增或减调节,并且可包括对总体调节的大小的限制,例如以避免错误的术中测量。 Such adjustment may be adjusted or increased or reduced to adjust the ratio of the preoperative information, and may include a limitation upon the overall size adjustment, for example, to avoid erroneous operation of the measurement.

[0032]神经释放系统70还可接收椎间盘高度的测量,并使用这些测量来确定是否已实现计划或所需的神经释放。 [0032] release of the nervous system 70 may also receive disc height measurement, and use these measurements to determine whether planned or achieve the desired nerve release. 神经释放系统70可将椎间盘高度包括到表示神经孔间隙的总体计算中,或者可将椎间盘高度用作具有自己的独立阈值的独立参数。 Nervous delivery system 70 comprises a disc height may be calculated to represent the overall neural clearance hole, or may be used as independent parameters of disc height with its own independent threshold. 神经释放系统70可单独地使用孔高度、宽度和深度,它们各自具有自己的独立阈值。 Nervous system release hole 70 may be used alone height, width and depth, each having its own independent threshold. 神经释放系统70还可另选地使用比率,诸如孔高度与椎间盘高度的比率,该比率同样具有自己的独立阈值。 Nervous delivery system 70 may also alternatively be used ratios, the ratio of the height of the hole, such as disc height, which also has its own independent rate threshold.

[0033]神经间隙监测系统72可以多种实施方案来实施。 [0033] Neural gap monitoring system 72 may be implemented in various embodiments. 例如,神经间隙监测系统72可为图像引导式外科系统210。 For example, nerve monitoring system 72 may be a gap image guided surgical system 210. 如图2a所示,图像引导式外科系统210包括以与脊柱结构的已知定义关系在已知定义位置处放置在脊柱上的标记物212。 , The image guided surgery system defined in FIG. 2a 210 comprises a known relationship with the spinal column on the spine is placed at a known position marker 212 is defined. 图像引导式外科系统210还包括从标记物212接收信号的图像引导式外科系统接收器214。 The image-guided surgery system also includes a receiver 210 from an image guided surgical system receives signals marker 212,214. 图像引导式外科系统210处理信号并计算标记物的空间位置。 The image guided surgery system 210 processes the signals and calculates the spatial position of the marker. 图像引导式外科系统210基于标记物的空间位置以及表示脊柱结构的术前计划信息来确定脊柱的估计模型。 The image guided surgical system 210 based on the spatial position of the marker indicating the preoperative planning information to determine the configuration of the spine estimation model of the spine. 图像引导式外科系统210然后基于脊柱的估计模型和标记物的位置来确定对在插入植入物之前的现有神经孔间隙的表示的可用作基线(而不是术前估计的神经压迫量)的信息。 The image guided surgical system 210 and based on the position of the spine and the estimation model determines markers (nerve compression amount than before surgery estimate) of a conventional neural hole before insertion of the implant in the gap can be used as a baseline Information.

[0034]神经间隙监测系统72可为压力系统220。 [0034] nervous system gap 72 may be a pressure monitoring system 220. 如图2b所示,压力系统220包括压力传感器222,该压力传感器放置在神经压迫的相对侧上的脊柱上。 As shown in FIG. 2b 220 pressure system includes a pressure sensor 222, the pressure sensor is placed on the opposite side of the spinal nerve compression. 压力系统220还包括从压力传感器222接收信号的接收器224。 Pressure system 220 further includes a receiver 222 receives a signal from the pressure sensor 224. 压力系统220处理信号并计算神经压迫下的压力差。 Pressure system 220 processes the signals and calculates the pressure difference between the nerve crush. 压力差可用作对在插入植入物之前的神经孔间隙的表示的可用作基线的信息(例如,较小的差表示较大的神经孔间隙)。 The pressure difference may be used as the baseline information may be used to represent neural hole before the implant is inserted in the gap (e.g., a small difference indicates a large gap neural foramen). 压力系统220还可监测局部硬膜外压力变化和/或压力脉冲或波以在术中检测神经释放量。 Pressure system 220 may also monitor local epidural pressure variations and / or pressure waves or pulses in release to detect nerve surgery.

[0035]神经间隙监测系统72可为直接可视化系统230。 [0035] The neural monitoring system 72 may be a gap visualization system 230 directly. 如图2c所示,直接可视化系统230包括放置在器械236中的可转向相机232。 Shown in Figure 2c, direct visualization system 230 includes the device 236 is placed in the steerable camera 232. 器械236具有包括相机转向控件(未示出)的近侧端部以及包括可转向相机的远侧端部。 Device 236 having a proximal end portion of the steering control includes a camera (not shown) and a distal end comprising a steerable camera. 器械236的远侧端部设计有用于可视化脊柱的敞开区域。 The distal end of the instrument 236 is designed for the visualization of the spine open area. 如图所示,器械236包括被配置成邻接上椎体的相对平坦的上部231a以及被配置成邻接下椎体的相对平坦的下部231b(另选地,上部和下部可成形有弯曲部,该弯曲部被设计成匹配一般椎体终板的形状)。 As shown, the instrument 236 is configured to include a relatively flat upper portion adjacent vertebral bodies the vertebral body 231a and a lower abutment arranged relatively flat lower portion 231b (alternatively, the upper and lower bent portion may be formed with, the the curved portion is designed to match the general shape of the vertebral endplate). 上部231a与下部231b之间的间隙相当于椎间盘空间的高度。 The gap between the upper and lower portion 231a 231b corresponds to the height of the disc space. 可为多种器械提供不同的间隙以适应各种椎间盘空间高度。 Different gap may be provided various instruments to accommodate a variety of disc space height. 上部231a和下部231b可为锥形或斜面以促进在椎间盘空间内移动。 An upper portion 231a and lower portion 231b may be tapered or beveled to facilitate movement within the disc space. 上部231a和下部231b通过壁233互连。 An upper portion 231a and lower portion 231b 233 are interconnected by a wall. 壁233通常较窄以增大观察区域。 Generally narrow wall 233 to increase the viewing area.

[0036]直接可视化系统230还包括从相机232接收信号的图像引导式外科系统接收器234。 [0036] Direct visualization system also includes a receiver 230 from an image guided surgical system receives signals 232,234 camera. 直接可视化系统230基于来自相机的信号以及表示脊柱结构的术前计划信息来确定脊柱的估计模型。 Direct visualization system 230 to determine the model of the spine estimate based on a signal from the camera preoperative planning information indicating the structure of the spine. 直接可视化系统230还基于视频信号和脊柱的术前模型来确定表示神经孔间隙的信息。 Direct visualization system 230 model is further based on the video signal before surgery and spinal neural foramen to determine information represented by a gap. 该信息可被神经释放系统72用作基线,而不是术前估计的神经压迫量。 This information may be used as a baseline nervous delivery system 72, rather than before the surgery the estimated amount of nerve compression.

[0037]神经间隙监测系统72可为超声检测系统240。 [0037] neural monitoring system 72 may be a gap ultrasonic testing system 240. 如图2d所示,超声检测系统230包括超声探头242。 As shown in FIG. 2d 230 ultrasonic testing system 242 includes an ultrasound probe. 超声探头242定位在轨道241上以提供探头242的受控移动。 The ultrasound probe 242 is positioned on the rail 241 to provide controlled movement of the probe 242. 超声探头还可被手持或由各种其他的运动控制系统控制。 The ultrasonic probe may also be handheld or various other motion control system. 超声检测系统240还包括从超声探头242接收信号的超声接收器244。 Ultrasonic testing system 240 further includes an ultrasound receiver 242 receives signals from the ultrasound probe 244. 超声检测系统240基于来自超声探头242的信号以及表示脊柱结构的术前计划信息来确定脊柱的估计模型。 Ultrasonic testing system 240 based on a signal from the ultrasound probe 242, preoperative planning information indicating a configuration of the spine determining an estimated model of the spine. 超声检测系统240还基于超声探头242和脊柱的术前模型来确定表示神经孔间隙的信息。 Ultrasonic testing system 240 further based on the model of the ultrasound probe 242 before surgery and spinal neural foramen to determine information represented by a gap. 该信息可被神经释放系统72用作基线,而不是术前估计的神经压迫量。 This information may be used as a baseline nervous delivery system 72, rather than before the surgery the estimated amount of nerve compression.

[0038]神经间隙监测系统72可为可适形球囊系统250。 [0038] Neural gap monitoring system 72 may be compliant balloon system 250. 如图2e所示,可适形球囊系统250包括可适形球囊252。 Shown in Figure 2e, conformable balloon system 250 comprises a balloon 252 may be conformable. 可适形球囊系统250还包括从可适形球囊252接收信号的压力接收器254 ο可适形球囊系统250基于可适形球囊252中的压力来确定表示神经孔间隙的信息。 Conformable system 250 further comprises a balloon from a balloon-shaped adapter 252 receives a pressure signal receivers 254 ο conformable balloon pressure based system 250 may be compliant balloon 252 is determined information indicating gap neural foramen. 该信息可被神经释放系统72用作基线,而不是术前估计的神经压迫量。 This information may be used as a baseline nervous delivery system 72, rather than before the surgery the estimated amount of nerve compression.

[0039]神经间隙监测系统72可为肌电图系统260。 [0039] neural monitoring system 72 may be a gap EMG system 260. 如图2f所示,肌电图系统260包括荧光镜262。 As shown in FIG 2f, EMG system 260 includes a fluoroscope 262. 肌电图系统260还包括从荧光镜262接收信号的荧光检查接收器264。 EMG system 260 further includes a fluoroscope receiver for receiving signals from the fluoroscopic 262,264. 为了提高荧光检查信号的质量,可为患者注射造影剂以帮助确定神经压迫和/或收缩。 To improve the quality of the signal fluoroscopy, contrast agent is injected to the patient may help to determine nerve crush and / or contraction. 肌电图系统260基于来自荧光镜262的信号以及表示脊柱结构的术前计划信息来确定脊柱的估计模型。 EMG system 260 to determine an estimated model based on a signal from the spine of the fluoroscope 262 preoperative planning information indicating a configuration of the spine. 肌电图系统260还基于荧光镜262和脊柱的术前模型来确定表示神经孔间隙的信息。 EMG system 260 further based on preoperative fluoroscopic model 262 to determine information and spinal nerve clearance holes FIG. 该信息可被神经释放系统72用作基线,而不是术前估计的神经压迫量。 This information may be used as a baseline nervous delivery system 72, rather than before the surgery the estimated amount of nerve compression.

[0040]如步骤120所示,外科医生执行初始椎间盘清理。 [0040] As shown in step, the surgeon performs an initial cleaning disc 120. 执行椎间盘清理是为了为融合笼留出空间并且暴露椎体的据信有助于融合过程的终板。 Performing cleaning disc to allow space for the fusion cage and is believed to contribute to the exposed vertebral endplate fusion process. 外科医生还可将试验物放置在已清理的椎间盘空间中以获得针对椎间盘空间清理效果的触感。 The surgeon will also test were placed in the disc space has been cleaned to obtain tactile effects for the clean-up disc space. 试验物还可用于确定特定尺寸的植入物是否将适配在椎间盘空间中。 Test may also be used to determine whether a particular size implant will fit within the disc space.

[0041]在步骤130处,外科医生将可扩展试验植入物插入已清理的椎间盘空间中并调节可扩展试验植入物,同时监测负荷和/或接触面积。 [0041] At step 130, the surgeon may extend the trial implant into the intervertebral disc space has been cleaned and adjusted expandable trial implant, while monitoring the load and / or contact area. 图3a中示出了用于监测负荷和/或接触面积的示例性可扩展试验植入物300。 Figure 3a shows a load monitoring and / or exemplary expandable trial implant 300 to the contact area. 如在图3a中可见,可扩展试验植入物300具有位于该植入物的横向侧上的凹陷部310。 As can be seen in FIG. 3a expandable trial implant 300 has a recessed portion 310 on the lateral side of the implant. 凹陷部310允许外科医生插入附加椎间盘清理工具以选择性地移除靠近植入物的任一或两个横向侧的更多组织。 Recess 310 allows the surgeon to insert an additional disc cleaning tool to selectively remove more tissue near either or both lateral sides of the implant. 此外,外科医生还可选择性地移除靠近植入物的远侧和/或近侧部分的组织。 In addition, the surgeon may selectively removing the implant near the distal and / or proximal portion of the tissue. 脊柱矫形系统50可有助于确定要移除哪个区域的组织以便实现计划神经释放量。 Orthopedic spinal system 50 may help determine which areas of tissue to be removed in order to achieve the planned release of nerve.

[0042]根据所执行的手术的类型,植入物的横向侧可进入椎间盘的不同部分。 [0042] According to the type of surgery being performed, the lateral side of the implant may enter different parts of the disc. 例如,在采用侧路的脊柱手术(诸如图3a所示)中,试验植入物的横向侧将面向椎间盘的前部部分和后部部分。 For example, in spinal surgery using the side passage (such as in FIG. 3a), the lateral side of the trial implant facing the front portion and a rear portion of the disc. 在采用前路的脊柱手术(未示出)中,试验植入物的横向侧将面向椎间盘的前部部分和后部部分。 In spinal surgery (not shown), the lateral side of the trial implant facing the front portion and a rear portion of the anterior disc employed.

[0043]图3b为可扩展试验植入物300的顶视图。 [0043] Figure 3b is a top view of the expandable implant 300 of the trial. 如图3b所示,可扩展试验植入物300包括被配置成邻接上椎体的相对平坦的上表面305。 3b, expandable trial implant 300 is configured to include a relatively flat upper surface 305 adjacent to the vertebral body. 可扩展试验植入物300还包括被配置成邻接下椎体的相对平坦的下表面(未示出)。 Expandable trial implant 300 further comprises a lower vertebral body configured to abut a relatively flat lower surface (not shown). 上表面305和下表面可为锥形或轮廓形成为与典型的椎体终板适形。 An upper surface and a lower surface 305 may be formed as a typical vertebral endplate is tapered or conformal profile. 同样为了匹配典型的椎体构型,上表面305和下表面可彼此大致平行或者可以大致前凸或大致后凸的构型成角度。 Also in order to match the typical configuration of the vertebral body, an upper surface and a lower surface 305 may be substantially parallel to each other or may substantially lordotic or kyphotic configuration substantially angled.

[0044] 如图3b所示,上表面305包括多个负荷传感器320。 [0044], the upper surface 305 in FIG. 3b comprises a plurality of load sensors 320. 下表面也可包括多个负荷传感器(未示出)。 The lower surface may also include a plurality of load sensors (not shown). 负荷传感器可为压力传感器、负荷传感器或能够感测压力或负荷的任何其他装置。 A load sensor may be a pressure sensor, a load sensor, or any other device capable of sensing or measuring the pressure load. 负荷传感器320布置在顶部表面上并且沿可扩展试验植入物300的横向侧设置。 Load sensor 320 is disposed on the top surface and the lateral side direction expandable trial implant 300. 负荷传感器320还可靠近植入物的远侧端部和近侧端部定位。 Load sensor 320 may be a proximal end and a distal end portion positioned close to the implant. 虽然负荷传感器320被示出为成行和列地定位,但负荷传感器320可位于上表面305和下表面上的各个位置处。 Although the load cell 320 is shown as being positioned in rows and columns, the load sensor 320 but may be at various locations on the surface 305 and the lower surface of the upper. 负荷传感器的间隙可以是一致的或者可以在外科医生较关注的区域中较密,例如,在周边周围,而不是在上表面和下表面的中心区中,间隙可以较密。 Load cell gap may be uniform or may be denser in the region of interest than the surgeon, for example, around the perimeter, instead of the upper surface and the lower surface of the central region, the gap can be more dense.

[0045]负荷传感器320与负荷与接触系统65通信以在可扩展试验植入物300正扩展时提供与其上的负荷有关的信息。 [0045] The load sensor 320 in communication with the load and the contact system 65 to provide information about its load when the expandable trial implant 300 is being extended. 负荷与接触系统65可确定是否以及何时与椎体接触。 Load and contact system 65 may determine whether and when in contact with the vertebral body. 负荷与接触系统65可将大于某个阈值负荷的负荷解译为对已与椎体接触的指示。 Load system 65 may be in contact with a load greater than a certain threshold value is interpreted as an indication of the load has been in contact with the vertebral body. 负荷与接触系统65可向外科医生指示接触何时发生(以视觉方式、听觉方式或这两种方式指示,并且可经由神经释放系统70和显示器74来指示)。 Load and contact system 65 may indicate to the surgeon when contact occurs (visually, aurally or both ways indicated, and may be indicated via the nervous system release 70 and display 74).

[0046]另选地,上表面305和下表面可包括接触开关或传感器以指示何时与椎体接触。 [0046] Alternatively, the upper surface and the lower surface 305 may include a contact switch or sensor to indicate when the contact with the vertebral body. 另选地,上表面305和下表面可包括传感器的膜或片材以用于确定上表面和下表面上各位置处的接触面积/负荷。 Alternatively, the upper surface and the lower surface 305 may include a film or sheet of a sensor for determining the contact area / position of a load at the respective upper and lower surfaces.

[0047]图4a至图4c示出了显示器74可如何示出可扩展试验植入物300上的负荷和接触的示例性实施方案。 [0047] Figures 4a-4c show how a display 74 illustrates an exemplary embodiment of the expandable load contact 300 of the trial implant. 如图4a所示,图形视图400(其可由负荷与接触系统65和/或神经释放系统70生成并且在显示器74上显示)示出了可扩展试验植入物300的上部表面上的负荷和接触。 As shown, a graphical view 400 (which may be in contact with the loading system 65 and / or the nervous system release 70 generates and displayed on the display 74) 4a shows a load on the upper surface of the trial implant 300 may be extended and a contact . 如图形视图420所示,区域402指示高负荷,区域403指示中度负荷,并且区域404指示低负荷。 The graphics view 420, the region 402 indicates a high load, medium load indication area 403, and 404 indicates a low-load region. 这些指示可用颜色、值、颜色和值来实施,可包括缩放图形显示器以实现更多或更少分辨率的能力等。 These indicating the available color values, and color values ​​embodiments, scaling may include a graphical display capability to achieve more or less resolution, and the like. 视图420中还示出了可扩展试验植入物300的下部表面上的负荷。 View 420 also shows the load on the lower surface of the expandable trial implant 300. 如图所示,区域422指示高负荷,区域423指示中度负荷,并且区域424指示低负荷。 As shown, the region 422 indicates a high load, medium load region indicated 423 and 424 indicate the low load region.

[0048] 如图4b所示,图形视图430示出了可扩展试验植入物300的上部表面上的负荷。 [0048] Figure 4b, a graphical view 430 shows a load on the upper surface of the expandable trial implant 300. 如图形视图430所示,区域432指示高负荷,区域433指示中度负荷,并且区域434指示高负荷。 The graphics view 430, the region 432 indicates the high load, medium load region indicated 433 and 434 indicate a high load region. 视图440中还示出了可扩展试验植入物300的下部表面上的负荷。 View 440 also shows the load on the lower surface of the expandable trial implant 300. 如图所示,区域442指示高负荷,区域443指示中度负荷,并且区域444指示高负荷。 As shown, the region 442 indicates a high load, medium load region indicated 443 and 444 indicate a high load region.

[0049 ] 如图4c所示,图形视图450示出了可扩展试验植入物300的上部表面上的负荷。 [0049] As shown in FIG. 4c, a graphical view 450 shows a load on the upper surface of the expandable trial implant 300. 如图形视图450所示,区域452指示低负荷,区域453指示低负荷,并且区域454指示低负荷。 The graphics view 450, the region 452 indicates the low load, low load region indicated 453 and 454 indicate the low load region. 视图460中还示出了可扩展试验植入物300的下部表面上的负荷。 View 460 also shows the load on the lower surface of the expandable trial implant 300. 如图所示,区域462指示低负荷,区域463指示低负荷,并且区域464指示低负荷。 As shown, the region 462 indicates a low load, low load region indicated 463 and 464 indicate the low load region.

[0050]仍然在步骤130处,外科医生使可扩展试验植入物300扩展但是在负荷增加至超过预定义阈值之前停止,该预定义阈值可为例如为了考虑对终板的损坏而已示出的阈值。 [0050] In still At step 130, the surgeon may extend the trial implant 300 expansion but increased load before stopping beyond a predefined threshold, the predefined threshold may be, for example, to consider the damage to endplates only shown threshold. 神经释放系统70从负荷与接触系统65接收用于表示可扩展试验植入物300的上部表面和下部表面上的负荷和接触面积的信息。 Nervous delivery system 70 and loading information indicating the contact area on the upper surface and the lower surface of the trial implant 300 may be extended from the load system 65 receives the contact.

[0051] 神经释放系统70可经由显示器74指示可扩展试验植入物300的上部表面和下部表面与椎体的终板之间何时发生首次接触。 [0051] nervous system release 70 may indicate via the display 74 may be extended when the first contact between the trial implant upper and lower surfaces of the vertebral end plate 300. 神经释放系统70还可经由显示器74以图形方式显示可扩展试验植入物300的上部表面和下部表面上的每个负荷传感器何时接触椎体的终板。 Nervous delivery system 70 may also display each of the load sensors 74 on the upper and lower surfaces expandable trial implant 300 when contacting the endplate of the vertebral body via a graphical display. 神经释放系统70还可经由显示器74指示可扩展试验植入物300的上部表面和下部表面的四个拐角中的每个拐角何时接触椎体的终板。 Nervous delivery system 70 may also indicate via the display 74 can be extended four corners of the trial implant of the upper and lower surfaces 300 of each of the corners when contacting the vertebral endplates.

[0052]神经释放系统70将负荷信息与预定义阈值进行比较。 [0052] nervous load information delivery system 70 with a predefined threshold value. 该阈值可向外科医生警告可能即将发生的终板损坏。 The warning threshold may damage the endplates may be imminent to the surgeon. 预定义阈值可为应用于每个负荷传感器的单个负荷阈值、可为表示可扩展试验植入物300的一个或两个表面上的每个负荷传感器的平均值的平均负荷阈值,或者预定义阈值可为单个阈值和平均阈值的组合,所述单个阈值和平均阈值中的任一者都将向外科医生触发信号。 A predefined threshold may be applied to a single load threshold for each load cell, may be extended to represent the average of the average load threshold for each load cell on one or both surfaces of the trial implant 300, or a predefined threshold It may be a combination of a single threshold value and the average threshold value, any one of single threshold value and the average of the threshold values ​​are the surgeon will trigger signal. 在达到或超过预定义阈值时,显示器74或神经释放系统70可以视觉方式和/或听觉方式向外科医生指示。 When reached or exceeded a predefined threshold, display 74 or nervous system release 70 may visually and / or audibly indicated to the surgeon.

[0053] 在步骤140处,外科医生测量神经孔释放。 [0053] At step 140, the surgeon measuring release neural foramen. 外科医生用图2a至图2f中更具体地示出的多种神经间隙监测系统72中的任一个来执行该操作。 Any of a variety of neurological gap 72 monitoring system surgeon to more specifically illustrated by FIG. 2a to 2f a to perform the operation. 神经间隙监测系统72将信息发送到神经释放系统70以供处理。 Nervous gap monitoring system 72 to transmit information to the nervous system release 70 for processing. 如果神经释放系统70确定所测得的神经孔释放等于或大于计划神经孔释放,则在步骤150处,神经释放系统70经由显示器74指示孔被充分释放,并且外科医生前进至步骤170并将融合植入物置于椎间盘空间中。 If the neural foramen delivery system 70 determines the measured release neural or more planned release hole, then at step 150, nervous system release 70 is fully released via the display 74 indicates the hole, and the surgeon proceeds to step 170 and the fusion the implant is placed in the disc space. 上文讨论了用于确定是否已实现所需或计划神经释放的示例性算法。 It discusses illustrative algorithm for determining whether a plan has been required to achieve or nerve release above.

[0054]如果神经释放系统70确定所测得的神经孔释放未达到计划神经孔释放,则在步骤150处,神经释放系统70指示孔未被充分释放,并且外科医生前进至步骤160并基于由神经释放系统70和负荷与接触系统65提供的反馈来清理更多的椎间盘空间。 [0054] If the system 70 determines the release neural foramen measured does not reach the planned release neural release hole, then at step 150, the system 70 instructs nervous release hole is not sufficiently released, and the surgeon proceeds to step 160 and based on the release neural feedback system 70 and the load 65 provided with a contacting system to clean more disc space. 神经释放系统70可向外科医生指示应进一步清理椎间盘的哪些区域。 The nervous system to release 70 may indicate which areas should further clean the disc to the surgeon. 神经释放系统70可基于所测得的神经释放量以及可扩展试验植入物300上所测得的负荷,并且基于所测得的负荷的变化与所测得的神经释放的所得变化之间的已确定的相关性来确定所述区域。 The resulting change in the release between the nervous system 70 may be based on the measured nerve growth test and a release implant 300 the measured load, and based on the change of the measured load and the measured release of nerve determining the correlation of the determined region. 所述相关性可针对单个患者确定,可基于关于多个患者的历史数据(例如,来自数据聚合系统80),或者这两者的组合。 The correlation can be determined for individual patients, based on patient history data on a plurality (e.g., from a data aggregation system 80), or a combination of the two. 神经释放系统70可向外科医生提供对要在何处从椎间盘空间移除更多组织的图形指示,类似于图4a至图4c中的那些。 Nervous delivery system 70 may provide a graphical indication of more tissue to be removed from the disc space where a surgeon, similar to those in FIG. 4a to 4c. 例如,神经释放系统70可通过上位视图、侧位视图和前位视图以图形方式示出椎体并且用颜色指示外科医生应从椎间盘的哪些区域移除更多组织来实现计划神经释放。 For example, system 70 may be released by nerve upper view, lateral view and a front view of the bit shown graphically and vertebral color region which should indicate the surgeon to remove disc tissue is achieved more release neural programs.

[0055]在完成步骤160后,方法10回到步骤130,在该步骤中,外科医生将再次将可扩展试验植入物300置于椎间盘空间中并使试验物扩展同时监测负荷和接触面积。 [0055] After completion of step 160, the method 10 returns to step 130, in this step, the surgeon will again be extended trial implant 300 is placed in the disc space and the test was extended while monitoring the load and contact area. 重复该过程,直至IJ实现计划神经孔释放量,或者直到达到其他限制,诸如最大椎间盘空间收缩量、最长手术时间、神经病痛测量结果、或其他此类项目(流程图中未示出)。 This process is repeated until the hole IJ achieve planned release neural, or until other restrictions, such as the maximum amount of shrinkage disc space, the longest operation time, neuropathic pain measurements, or other such items (not shown in the flow chart).

[0056]图5a至图5h示出了可与图1a的方法结合使用而不是与可扩展试验植入物300组合使用的另一可扩展试验植入物500的示例性实施方案。 [0056] Figures 5a to 5h illustrate a method used in conjunction with FIG. 1a instead of the combination 300 may be further extended trial implant expandable trial implant 500 of the exemplary embodiment. 可扩展试验植入物500包括上部部分510、下部部分530、以及位于上部部分510与下部部分530之间的扩展部分550。 Expandable trial implant 500 includes an upper portion 510, a lower portion 530, and an extended portion 550 between the portion 510 and a lower portion 530 at the top.

[0057]上部部分510的形状为大致矩形,具有大致平坦的上表面511(但其形状可为大致中凸或其他形状,并且被配置成与具有典型形状的椎体终板配合),并且被配置成接触靠上定位的椎体。 [0057] The shape of the upper portion 510 is substantially rectangular, having a generally planar upper surface 511 (but it may be a substantially convex shape or other shape, and is configured to have a typical shape of the vertebral endplate fit), and is configured to contact against the upper vertebral body positioned. 上部部分510包括位于上表面511上的负荷传感器502。 An upper portion 510 includes a load sensor located on the upper surface 511,502.

[0058] 上部部分510包括远侧部分514和近侧部分515。 [0058] The upper portion 510 includes a distal portion 514 and proximal portion 515. 上部部分510的远侧部分514可为锥形和/或斜面的以允许更容易地插入椎间盘空间中。 An upper portion 510 of the distal portion 514 may be tapered and / or beveled to permit easier insertion into the disc space. 上部部分510的近侧部分515同样可为锥形和/或斜面的以允许更容易地从椎间盘空间中移除并且将通常具有比远侧部分514小的锥度/斜度。 An upper portion 515 of the proximal portion 510 may likewise be tapered and / or beveled to permit easier removal from the disc space and having a generally smaller than the distal portion 514 of the taper / slope.

[0059]下部部分530的形状为大致矩形,具有大致平坦的下表面531(但其形状可为大致中凸或其他形状,并且被配置成与具有典型形状的椎体终板配合),并且被配置成接触靠下定位的椎体。 Shape [0059] The lower portion 530 is substantially rectangular, having a generally flat lower surface 531 (but it may be a substantially convex shape or other shape, and is configured to have a typical shape of the vertebral endplate fit), and is configured to contact against the targeted vertebral body. 下部部分530包括位于下表面531上的负荷传感器502。 A lower portion 530 includes a sensor 502 under a load of 531 on the surface.

[0060] 上部部分530包括远侧部分534和近侧部分535。 [0060] The upper portion 530 includes a distal portion 534 and proximal portion 535. 上部部分530的远侧部分534可为锥形和/或斜面的以允许更容易地插入椎间盘空间中。 An upper portion 530 of the distal portion 534 may be tapered and / or beveled to permit easier insertion into the disc space. 上部部分530的近侧部分535同样可为锥形和/或斜面的以允许更容易地从椎间盘空间中移除并且将通常具有比远侧部分534小的锥度/斜度。 An upper portion 535 of the proximal portion 530 may likewise be tapered and / or beveled to permit easier removal from the disc space and having a generally smaller than the distal portion 534 of the taper / slope.

[0061] 上部部分510包括从上表面511大致向下延伸并且位于远侧部分514与近侧部分515之间的横向侧壁520。 [0061] The upper portion 510 includes a sidewall 520 extending laterally and located between the distal portion 514 and proximal portion 515 from the upper surface 511 substantially downward. 下部部分530包括从下表面531大致向上延伸并且位于远侧部分534与近侧部分535之间的横向侧壁540。 A lower portion 530 includes a sidewall 540 extending laterally and located between the distal portion 534 and proximal portion 535 substantially upwardly from the lower surface 531.

[0062] 侧壁520,540不是大致平坦的,而是包括凹形区段并且共同形成可扩展试验植入物500的横向部分中的C形,如图5f的视图中充分展示。 [0062] The side walls 520, 540 is not substantially planar, but includes a concave section and together form a C-shaped transverse portion of the trial implant 500 may be extended in view of FIG. 5f show sufficiently. 该C形在植入物的每个侧上都提供了用于插入和使用椎间盘清理工具的区域517。 The C-shaped on each side of the implant provides a region 517 for disc insertion and use of cleaning tools. 虽然可扩展试验植入物500—般来讲包括镜像以及对称的上部部分510和下部部分530,但植入物500也可以是不对称的。 Although the extension trial implant 500 comprises an upper generally in terms of symmetry and mirror portion 510 and a lower portion 530, the implant 500 may also be asymmetrical. 此外,不是每个侧壁都必须包括凹形区段;凹陷可以仅包括在一个部分中。 Moreover, each side wall must not include a concave section; may include a recess portion only. 此外,凹形区段可以是为椎间盘移除工具(下文更详细地描述)提供凹陷区域的任何形状,诸如矩形凹陷部、正方形凹陷部或其他形状。 Further, the concave portion may be a tool for the removal of the disc (described in more detail below) providing a recessed region in any shape, such as a recess, rectangular, square or other shape depressions.

[0063] 侧壁520包括从近侧部分515延伸到远侧部分514的沟槽516(但沟槽516不一定一直延伸到远侧部分514)。 [0063] The sidewall 520 includes (but is not necessarily a groove 516 extending to the distal portion 514) extending from the proximal portion 515 of the groove 516 to the distal portion 514. 侧壁540还包括从近侧部分535延伸到远侧部分534的沟槽516(但沟槽536不一定一直延伸到远侧部分534)。 Sidewall 540 further includes (but is not necessarily trench 536 extends to the distal portion 534) extending from the proximal portion 535 to the distal portion 534 of the groove 516. 沟槽516具有矩形横截面并且其尺寸和构造使得其与椎间盘清理工具的一部分配合以导向和保持下文更详细描述的椎间盘清理工具。 Channel 516 having a rectangular cross section and is sized and configured such that a portion of the disc cooperate to clean the tool guide and tool holder disc cleaning described in more detail below. 虽然沟槽516被示出为具有矩形横截面,但横截面可具有各种形状以配合椎间盘清理工具,诸如圆形、正方形、燕尾形等。 Although channel 516 is shown as having a rectangular cross-section, but the cross section may have various shapes to fit disc cleaning tools, such as circular, square, dovetail like.

[0064] 设置在上部部分510与下部部分530之间的扩展部分550包括螺纹杆部分554、两个楔形件552(其具有内螺纹并且与杆部分554的螺纹配合)、以及连接到杆部分554以旋转杆部分554的轴部分570。 [0064] 550 disposed between the extension portion 530 includes an upper portion 510 and a lower threaded shank portion 554, two wedges 552 (and which has an internal thread portion screwed with the rod 554), and a connecting portion 554 to the rod shaft portion 570 to rotate the lever portion 554. 在轴部分570旋转时,螺纹杆部分554也旋转。 When the shaft portion 570 is rotated, the threaded rod portion 554 also rotates. 扩展部分还可包括用于扩展的其他机构,包括球囊、活塞、千斤顶、垫片等。 Extension may also include other means for expansion, including a balloon, a piston, jacks, gaskets and the like.

[0065] 螺纹杆部分554包括中心圆形凸缘556以及位于中心凸缘的任一侧上的两个具有相对螺纹的部分558和559。 [0065] including two on either side of the central circular flange 556 and a central flange portion 554 having a threaded shank portion 558 and the counter-thread 559. 中心凸缘556分别与位于上部部分510下侧和下部部分530上侧的弓形凹陷部525,545配合。 525,545 flange portion 556 with an arcuate central portion 530 are located on the upper side of the lower portion 510 and a lower side of the recess. 螺纹杆部分554的旋转使楔形件552在相反的方向上移动,SP,朝向彼此,或者远离彼此。 Rotating the threaded rod portion 554 of the wedge member 552 moves in the opposite direction, SP, towards each other or away from each other. 在楔形件552朝向彼此移动时,它们沿位于上部部分510下侧和下部部分530上侧的斜坡移动,从而使上部部分510和下部部分530扩展开。 When the wedge member 552 towards each other, they are moved along the slope portion 530 located on the lower side of an upper portion 510 and a lower side, so that the upper portion 510 and lower portion 530 spread apart.

[0066] 轴部分570包括驱动轴571、植入物配合部分573和工具导向部分580。 [0066] The shaft portion 570 includes a drive shaft 571, mating portions 573 and implant tool guide portion 580. 如图5f充分展示,工具导向部分580包括轴配合区段582和工具配合区段584。 FIG. 5f fully demonstrated, the tool guide portion 580 includes a shaft portion 582 and mating tool-engaging section 584. 轴配合区段582沿驱动轴571纵向延伸并且具有C形横截面,该C形横截面的尺寸和构造使得其扣合到驱动轴571上。 Fitting shaft portion 582 extends longitudinally along the drive shaft 571 and having a C-shaped cross-section, the C-shaped cross-sectional size and configuration such that it is snapped onto the drive shaft 571. 工具配合区段584沿轴配合区段582纵向延伸并且具有C形横截面,该C形横截面的尺寸和构造使得其与椎间盘清理工具配合。 Tool-engaging section 584 along the mating axis 582 and has a longitudinal section extending C-shaped cross-section, the C-shaped cross-sectional size and configuration such that the disc cooperating with cleaning tools. 轴部分570还包括位于轴配合区段582与工具配合区段584之间的相机586。 Shaft portion 570 further comprises a shaft fitted with a tool-engaging portion 582 between the camera section 584 586. 相机586与负荷与接触系统65或神经释放系统70电连通,该负荷与接触系统或神经释放系统继而向显示器74提供信息以显示椎间盘空间的相机图像并帮助外科医生执行椎间盘移除。 Camera system 586 in contact with the load 65 or the nervous system release 70 in electrical communication with the contact system load or release nervous system which in turn provides information to the display 74 to display a camera image of the disc space and to help the surgeon perform the disc removed.

[0067]可扩展试验植入物500可与椎间盘移除工具590机械地协作以允许外科医生移除椎间盘的区段。 [0067] The expandable trial implant removal tool 500 may be mechanically cooperates with the disc 590 to allow the surgeon to remove disc section. 这可例如在神经释放系统70确定应移除椎间盘的特定区域之后发生,如上所述。 This may be, for example, after the release of nervous system 70 determines a specific area of ​​the disc should be removed occur, as described above.

[0068] 椎间盘移除工具590包括轴591和切割工具594。 [0068] The disc removal tool 591 includes a shaft 590 and cutting tool 594. 切割工具594被示出为具有形成正方形的四个壁的美工刀,该正方形具有圆角以及穿过该正方形的孔。 The cutting tool 594 is shown having a square utility knife four walls forming a square with rounded corners and the square through hole. 所述臂具有锋利边缘以切割椎间盘材料。 The arm has a sharp edge to cut the material disc. 切割工具594可呈常用于椎间盘切割或移除的任何其他常规切割工具的形状。 The shape of the cutting tool 594 may be any other conventional cutting tool is used to cut or remove the intervertebral disc.

[0069] 切割工具594在铰链592处可枢转地连接到轴591。 [0069] The cutting tool 594 in the hinge 592 is pivotably connected to the shaft 591. 铰链592允许切割工具594围绕枢转点进行关节运动并从椎间盘空间切割椎间盘。 The hinge 592 allows the cutting tool 594 for articulation about a pivot point and the cutting disc from the disc space. 切割工具594可通过互连的驱动轴或滑轮或通过用于机械地产生枢转移动的任何其他常规方法来进行关节运动。 The cutting tool 594 may be used to mechanically any other conventional methods used to produce pivotal movement of articulated interconnected by a drive shaft or a pulley or via. 椎间盘移除工具590包括手柄(未示出)和触发机构(未示出),供外科医生在移除椎间盘材料时控制关节运动角度。 Disc removal tool 590 includes a handle (not shown) and a trigger mechanism (not shown) for the surgeon to control articulation angle during removal of disc material. 切割工具594也可以是非关节运动切割元件,该元件的尺寸和构造使得其与下文更详细描述的可扩展试验植入物500配合。 The cutting tool 594 may be non-articulation cutting element, the element is sized and configured such that it can be expanded in conjunction with the trial implant 500 described in more detail below.

[0070] 椎间盘移除工具590的轴591设置在可扩展试验植入物500的工具配合区段584的C形横截面中,如图5h所示。 [0070] axis of the disc removal tool 590 591 C-shaped cross section provided at the tool may be extended with the trial implant 500 of section 584, as shown in FIG 5h. 这允许椎间盘移除工具590相对于可扩展试验植入物500纵向移动。 This allows the disc 500 moves the removal tool 590 with respect to the longitudinal expandable trial implant. 轴591包括沿轴591的长度延伸的纵向突起部596。 Shaft 591 includes a longitudinal protrusion 596 extends along the length of the shaft 591. 如图所示,纵向突起部596在横截面上为大致矩形,并且其尺寸和构造使得其与可扩展试验植入物500的横向凹陷部545中的沟槽516配合并被接收在该沟槽中。 As shown, the longitudinal protrusion 596 is substantially rectangular in cross section, and is sized and configured such that it can be extended 516 cooperate with the trial implant trench lateral recesses 545,500 and received in the groove in. 它们之间的配合通过将轴591的运动限制为纵向运动并且阻止旋转运动来稳定椎间盘移除工具590。 Fit between them by limiting the movement of the shaft 591 to prevent longitudinal movement and rotational movement of the removal tool 590 to stabilize the disc. 这可为外科医生提供增加的稳定性以帮助移除椎间盘材料。 This can provide increased stability for the surgeon to remove disc material help. 另选地,轴591可不包括纵向突起部596,从而允许外科医生能够在适当的时候旋转轴591。 Alternatively, the shaft 591 may not include a longitudinal protrusion 596, allowing the surgeon to be rotatable shaft 591 at the appropriate time. 可提供一种具有多个切割工具的套件,每个切割工具具有和不具有纵向突起部596,从而使外科医生能够在适当的时候选择增加的稳定性并且在适当的时候选择增加的灵活性。 Kits can be provided having a plurality of cutting tool, each cutting tool and without having longitudinal protrusions 596, so that the surgeon can choose to increase stability at the appropriate time and increased flexibility in selecting the appropriate time.

[0071]图6a至图6h示出了可与图1a的方法结合使用而不是与可扩展试验植入物300或可扩展试验植入物500组合使用的可扩展试验植入物600的替代示例性实施方案。 [0071] Figures 6a to 6h illustrate the method used in conjunction with FIG. 1a is exemplary rather than alternative implant trial 300 may be extended or implant trial 500 may be used in combination extended trial implant 600 can be expanded embodiments. 可扩展试验植入物600包括上部部分610、下部部分630、以及位于上部部分610与下部部分630之间的扩展部分650。 Expandable trial implant 600 includes an upper portion 610, portion 650 between the lower extension portion 630, and 610 located in the upper portion and the lower portion 630.

[0072]上部部分610的形状为大致矩形,具有大致平坦的上表面511(但其形状可为大致中凸或其他形状,并且被配置成与具有典型形状的椎体终板配合),并且被配置成接触靠上定位的椎体。 [0072] The shape of the upper portion 610 is substantially rectangular, having a generally planar upper surface 511 (but it may be a substantially convex shape or other shape, and is configured to have a typical shape of the vertebral endplate fit), and is configured to contact against the upper vertebral body positioned. 上部部分610包括位于上表面611上的负荷传感器602。 An upper portion 610 includes a load sensor 602 is located on the upper surface 611.

[0073] 上部部分610包括远侧部分614和近侧部分615。 [0073] The upper portion 610 includes a distal portion 614 and proximal portion 615. 上部部分610的远侧部分614可为锥形和/或斜面得以允许更容易地插入椎间盘空间中。 The distal portion 614 of the upper portion 610 may be tapered and / or beveled to allow for easier insertion into the disc space. 上部部分610的近侧部分615同样可为锥形和/或斜面的以允许更容易地从椎间盘空间中移除并且将通常具有比远侧部分614小的锥度/斜度。 An upper portion 610 of the proximal portion 615 may likewise be tapered and / or beveled to permit easier removal from the disc space and generally has a smaller taper than the distal portion 614 / slope.

[0074]下部部分630的形状为大致矩形,具有大致平坦的下表面631(但其形状可为大致中凸或其他形状,并且被配置成与具有典型形状的椎体终板配合),并且被配置成接触靠下定位的椎体。 Shape [0074] The lower portion 630 is substantially rectangular, having a generally flat lower surface 631 (but it may be a substantially convex shape or other shape, and is configured to have a typical shape of the vertebral endplate fit), and is configured to contact against the targeted vertebral body. 下部部分630包括位于下表面631上的负荷传感器602。 It comprises a lower portion 630 located on the lower surface of the load sensor 631,602.

[0075] 上部部分630包括远侧部分634和近侧部分635。 [0075] The upper portion 630 includes a distal portion 634 and proximal portion 635. 上部部分630的远侧部分634可为锥形和/或斜面的以允许更容易地插入椎间盘空间中。 An upper portion 630 of the distal portion 634 may be tapered and / or beveled to permit easier insertion into the disc space. 上部部分630的近侧部分635同样可为锥形和/或斜面的以允许更容易地从椎间盘空间中移除并且将通常具有比远侧部分634小的锥度/斜度。 An upper portion 630 of the proximal portion 635 may likewise be tapered and / or beveled to permit easier removal from the disc space and generally has a smaller taper than the distal portion 634 / slope.

[0076] 上部部分610包括从上表面611大致向下延伸并且位于远侧部分614与近侧部分615之间的横向侧壁620。 [0076] The upper portion 610 includes a sidewall 620 extending laterally and located between the distal portion 614 and proximal portion 615 from the upper surface 611 substantially downward. 下部部分630包括从下表面631大致向上延伸并且位于远侧部分634与近侧部分635之间的横向侧壁640。 A lower portion 630 includes a sidewall 640 extending laterally and located between the distal portion 634 and proximal portion 635 substantially upwardly from the lower surface 631.

[0077] 侧壁620,640不是大致平坦的,而是包括凹形区段并且共同形成可扩展试验植入物600的横向部分中的C形,如图6g的视图中充分展示。 [0077] The side walls 620, 640 is not substantially planar, but includes a concave section and together form a C-shaped transverse portion of the trial implant 600 may be extended in view of FIG. 6g full display. 该C形在植入物的每个侧上都提供了用于插入和使用椎间盘清理工具的区域617。 The C-shaped on each side of the implant provides a region 617 for disc insertion and use of cleaning tools. 虽然可扩展试验植入物600—般来讲包括镜像以及对称的上部部分610和下部部分630,但植入物600也可以是不对称的。 Although the extension trial implant includes an upper mirror 600 and the like in terms of symmetrical portions 610 and lower portion 630, the implant 600 may also be asymmetrical. 此外,不是每个侧壁都必须包括凹形区段;凹陷可以仅包括在一个部分中。 Moreover, each side wall must not include a concave section; may include a recess portion only. 此外,凹形区段可以是为椎间盘移除工具(下文更详细地描述)提供凹陷区域的任何形状,诸如矩形凹陷部、正方形凹陷部或其他形状。 Further, the concave portion may be a tool for the removal of the disc (described in more detail below) providing a recessed region in any shape, such as a recess, rectangular, square or other shape depressions.

[0078] 侧壁620包括从近侧部分615延伸到远侧部分614的沟槽616 (但沟槽616不一定一直延伸到远侧部分614)。 [0078] The sidewall 620 includes (but is not necessarily trench 616 extends to the distal portion 614) extending from the proximal portion 615 to the distal portion 614 of the groove 616. 侧壁640还包括从近侧部分635延伸到远侧部分634的沟槽616(但沟槽636不一定一直延伸到远侧部分634)。 Sidewall 640 further includes (but is not necessarily trench 636 extends to the distal portion 634) extending from the proximal portion 635 to the distal portion 634 of the groove 616. 沟槽616具有矩形横截面并且其尺寸和构造使得其与椎间盘清理工具的一部分配合以导向和保持下文更详细描述的椎间盘清理工具。 Groove 616 has a rectangular cross section and is sized and configured such that a portion of the disc cooperate to clean the tool guide and tool holder disc cleaning described in more detail below. 虽然沟槽616被示出为具有矩形横截面,但横截面可具有各种形状以配合椎间盘清理工具,诸如圆形、正方形、燕尾形等。 Although trenches 616 are illustrated as having a rectangular cross-section, but the cross section may have various shapes to fit disc cleaning tools, such as circular, square, dovetail like.

[0079] 设置在上部部分610与下部部分630之间的扩展部分650包括由纵向构件652连接的远侧铰链651和近侧铰链653。 [0079] provided at an upper portion 610 and the lower extension portion 650 between the distal portion 630 includes a hinge 651 and a proximal hinge 653 connected by a longitudinal member 652. 远侧铰链651的形状大致为正方形,但可以呈任何形状,并且包括从远侧铰链651的相对侧横向延伸的两个横向突起部655。 Shape of the distal hinge 651 is generally square, but can be any shape, and includes a protrusion 655 extending laterally from two opposite lateral sides of the hinge 651 distally. 近侧铰链653的形状大致为环形,并且围绕杆654设置。 Shape proximal the hinge 653 is substantially annular and is disposed around the rod 654. 近侧铰链653包括从近侧铰链653的相对侧横向延伸的两个横向突起部655。 The hinge 653 includes a proximal portion 655 projecting from two opposite lateral sides extending transversely of the hinge 653 proximally.

[0080] 扩展部分650通过一系列四个千斤顶660连接至上部部分610和下部部分630,但可以存在任何数量的千斤顶660。 [0080] The extension portion 650 connected to the upper portion 610 and lower portion 630 by a series of four jacks 660, but there may be any number of jacks 660. 如图6。 6. 所不,每个千斤顶660包括被不出为660a和660b的至少两个纵向构件,所述纵向构件在枢转点处彼此枢转地互连并且枢转地互连到远侧铰链651的突起部655(或者近侧铰链653的突起部655)。 It does not, each comprising a jack 660 and 660a to 660b are not at least two longitudinal members, said longitudinal member at a pivot point pivotally interconnected to each other and pivotally interconnected to the distal projection 651 of the hinge section 655 (or the proximal portion of the hinge protrusion 653 655).

[0081 ] 杆654从手柄(未示出)朝向近侧铰链653延伸并且穿过近侧铰链。 [0081] 654 from the lever handle (not shown) of the hinge 653 extends proximally through the proximal and the hinge. 杆654止于两个延伸凸缘670。 Lever 654 extends beyond the two flanges 670. 第一延伸凸缘670朝向上部部分610的凹陷部向上延伸并且穿过该凹陷部。 A first flange 670 extending toward the upper portion of the recessed portion 610 and extends upwardly through the recess portion. 第二延伸凸缘670朝向下部部分630的凹陷部向下延伸并且穿过该凹陷部。 A second flange 670 extending toward the lower portion of the recessed portion 630 and extends downwardly through the recess portion. 延伸凸缘670还可作为过插止挡件,从而阻止外科医生将可扩展试验植入物600过远地过插入椎间盘空间中。 Extending through the plug flange 670 also serves as a stopper member, thereby preventing the surgeon expandable trial implant 600 is inserted too far through the disc space.

[0082]在相对于杆654纵向推动近侧铰链653时,千斤顶660被迫使将可扩展试验植入物600从压缩位置(诸如图6a所示)枢转移动并进入扩展位置(诸如图6b和6c所示)。 [0082] at 654 with respect to the longitudinal hinge rod 653 pushed proximally, the jack 660 will be forced to extend the trial implant 600 from a compressed position (as shown in FIG. 6a) and the pivoting movement into the extended position (FIG. 6b and such FIG 6c).

[0083]与可扩展试验植入物500—样,可扩展试验植入物600可包括如图5b和图5c所示的工具导向部分580。 [0083] with the expandable implant 500 Test samples expandable implant trial 600 may include a tool in FIG. 5b and 5c guide portion 580 as shown. 椎间盘移除工具590的轴591设置在可扩展试验植入物600的工具配合区段584的C形横截面(未示出)中。 Disc removal tool shaft 590 is disposed extensible tool 591 trial implant 600 with C-shaped cross-section of the section 584 (not shown). 这允许椎间盘移除工具590相对于可扩展试验植入物600纵向移动。 This allows the disc 600 moves the removal tool 590 with respect to the longitudinal expandable trial implant. 轴591包括沿轴591的长度延伸的纵向突起部596。 Shaft 591 includes a longitudinal protrusion 596 extends along the length of the shaft 591. 如图所示,纵向突起部596在横截面上为大致矩形,并且其尺寸和构造使得其与可扩展试验植入物600的横向凹陷部645中的沟槽616配合并接收在该沟槽中。 As shown, the longitudinal protrusion 596 is substantially rectangular in cross section, and is sized and configured such that it can mate with the grooves extend transversely recessed portion 645 of the trial implant 600 and 616 received in the groove . 它们之间的配合通过将轴591的运动限制为纵向运动并且阻止旋转运动来稳定椎间盘移除工具590。 Fit between them by limiting the movement of the shaft 591 to prevent longitudinal movement and rotational movement of the removal tool 590 to stabilize the disc. 这可为外科医生提供增加的稳定性以帮助移除椎间盘材料。 This can provide increased stability for the surgeon to remove disc material help. 另选地,轴591可不包括纵向突起部596,从而允许外科医生能够在适当的时候旋转轴591。 Alternatively, the shaft 591 may not include a longitudinal protrusion 596, allowing the surgeon to be rotatable shaft 591 at the appropriate time.

[0084]上述方法可以在每个步骤都要求操作员干预的手动分步方式实施,或者某些步骤可自动执行。 [0084] The above method may require operator intervention at each step manually embodiment sub-step embodiment, or that certain steps may be performed automatically. 自动步骤可由经由有线或无线通信通道与神经释放系统70通信的机械手装置执行。 Step automatic robot may communicate via a wired or wireless communication channel with the nervous system to release apparatus 70 performs. 自动步骤可以是完全自动的并且可实施为闭环系统,其中神经释放系统确定要发送至可控制可扩展试验植入物300和切割工具594的机械手装置的命令。 Automated steps can be fully automated and may be implemented as a closed loop system, wherein the neural release systems may be determined to be transmitted to a control command expandable trial implant 300 and the cutting tool 594 of the robot apparatus. 自动步骤可以是半自动的,要求外科医生或操作员在进行某些机械手步骤之前确认。 Automatic or semi-automatic step may be required before a surgeon or an operator in some robot confirmation step is performed.

[0085]虽然已经参照优选实施方案描述了本发明,但本领域技术人员将认识到,在不脱离本发明的精神的前提下,可以在形式和结构上做出改变。 [0085] Although the present invention has been described with reference to preferred embodiments, those skilled in the art will recognize that, without departing from the spirit of the present invention, changes may be made in form and structure.

Claims (24)

  1. 1.一种用于脊柱矫形的方法,包括: 从设置在椎间盘空间中的可扩展试验植入物接收负荷信息,所述植入物在移除椎间盘组织的一部分之后处于第一扩展位置; 将所述负荷信息与负荷阈值进行比较; 指示所述负荷信息何时超过所述负荷阈值; 从神经间隙监测系统接收表示神经孔间隙的信息,所述神经孔位于所述椎间盘空间近侧; 将表示神经孔间隙的所述信息与预定义孔间隙参数进行比较;以及基于表示神经孔间隙的所述信息与所述预定义孔间隙参数的比较来确定是否移除更多的所述椎间盘。 1. A method for spinal orthopedic, comprising: providing expandable trial implant receiving load information from within the disc space, the implant is in the first extended position after removal of a portion of the intervertebral disc; and the load information to the load threshold; indicating when the load information exceeds the load threshold; gap from the nervous system receives information indicating the monitoring gap neural foramen, the nerve proximal aperture in said disc space; indicating the information to predefined parameters of the neural foramen hole clearance gap compared; and indicating the information based on the neural foramen clearance hole with clearance comparing the predefined parameter to determine whether to remove more of the intervertebral disc.
  2. 2.根据权利要求1所述的方法,其中所述接收表示所述神经孔间隙的信息包括接收来自图像引导式外科系统的信息。 The method according to claim 1, wherein the receiving information indicative of a nerve gap aperture comprises receiving information from the image-guided surgical system.
  3. 3.根据权利要求1所述的方法,其中所述接收表示所述神经孔间隙的信息包括接收来自脊柱压力监测系统的信息。 3. The method according to claim 1, wherein the receiving information indicative of a nerve gap aperture comprises receiving information from a pressure monitoring system of the spine.
  4. 4.根据权利要求1所述的方法,其中所述接收表示所述神经孔间隙的信息包括接收来自可视化系统的信息。 4. The method according to claim 1, wherein the receiving information indicative of a nerve gap aperture comprises receiving information from the visualization system.
  5. 5.根据权利要求1所述的方法,其中所述接收表示所述神经孔间隙的信息包括接收来自超声检测系统的信息。 The method according to claim 1, wherein the receiving information indicative of a nerve gap aperture comprises receiving information from an ultrasonic detection system.
  6. 6.根据权利要求1所述的方法,其中所述接收表示所述神经孔间隙的信息包括接收来自球囊测量系统的信息。 6. The method according to claim 1, wherein the receiving information indicative of a nerve gap aperture balloon comprises receiving information from the measurement system.
  7. 7.根据权利要求1所述的方法,其中所述从所述可扩展试验植入物接收负荷信息包括从设置在所述试验植入物的下部表面和上部表面上的多个负荷传感器接收信息,以及将所述负荷传感器信息从设置在所述下部表面上的所述负荷传感器映射到至少两个区域中并且将所述负荷传感器信息从设置在所述上部表面上的所述负荷传感器映射到至少两个区域中。 7. The method according to claim 1, wherein said plurality of extended load on the lower surface of the trial implant includes a load information received from the test object disposed in the implant and the upper surface of the sensor information received from the , and the load sensor information map from the load sensor is provided on the lower surface of the at least two regions and the information from the load sensor is provided to the load sensor is mapped on the surface of the upper at least two regions.
  8. 8.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于负荷信息的所述映射区域中的至少一个区域来确定在哪里移除更多的所述椎间盘组织。 8. The method according to claim 1, wherein determining whether to remove more of the intervertebral disc comprises at least one region based on the load information mapping area is determined to remove more tissue where the intervertebral disc.
  9. 9.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于患者手术的历史信息来确定是否移除更多的所述椎间盘。 9. The method according to claim 1, wherein determining whether to remove more of the intervertebral disc includes historical information based on the patient to determine whether the surgical removal of the disc more.
  10. 10.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于从可视化系统接收的表示所述神经孔间隙的信息来确定是否移除更多的所述椎间盘。 10. The method according to claim 1, wherein determining whether to remove the disc comprises more based on information received from the visualization system represents the neural foramen to determine if the clearance of the intervertebral disc remove more.
  11. 11.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于从脊柱压力监测系统接收的信息来确定是否移除更多的所述椎间盘。 11. The method according to claim 1, wherein determining whether to remove the disc comprises more based on information received from the spine pressure monitoring system to determine whether to remove more of the intervertebral disc.
  12. 12.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于从球囊测量系统接收的信息来确定是否移除更多的所述椎间盘。 12. The method according to claim 1, wherein determining whether to remove more of the intervertebral disc includes a balloon based on information received from the measurement system to determine whether to remove more of the intervertebral disc.
  13. 13.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于从超声检测系统接收的信息来确定是否移除更多的所述椎间盘。 13. The method according to claim 1, wherein determining whether to remove the disc comprises more based on information received from the ultrasonic testing system to determine whether to remove more of the intervertebral disc.
  14. 14.根据权利要求1所述的方法,其中确定是否移除更多的所述椎间盘包括基于从图像引导式外科系统接收的信息来确定是否移除更多的所述椎间盘。 14. The method according to claim 1, wherein determining whether to remove the disc comprises more based on information received from the image guided surgical system to determine whether to remove more of the intervertebral disc.
  15. 15.—种用于脊柱矫形的系统,包括: 椎间盘移除工具;和可扩展试验物,所述可扩展试验物包括: 下部部分,所述下部部分具有被配置成接触下部椎体的下部表面, 上部部分,所述上部部分具有被配置成接触上部椎体的上部表面, 扩展装置,所述扩展装置设置在所述上部部分与所述下部部分之间并且被配置成增大所述下部部分与所述上部部分之间的距离,和第一横向侧,所述第一横向侧从所述下部表面延伸到所述上部表面,所述第一横向侧限定被配置成接收所述椎间盘移除工具的至少一部分的凹陷部。 15.- species for orthopedic spinal system, comprising: a disc removal tool; and scalable test substance, the test may be extended comprises: a lower portion, said lower portion having a lower surface configured to contact a lower portion of the vertebral body , an upper portion, said upper portion having means disposed between said upper portion and said lower portion and being configured to increase the lower surface of the upper portion is configured for contacting an upper vertebral body, the extension device, said extension and the distance between the upper portion of the first lateral side, the first lateral side extending from the lower surface to the upper surface of the first lateral side is configured to receive the defined disc removed at least a portion of the recess portion of the tool.
  16. 16.根据权利要求15所述的系统,其中所述可扩展试验物包括与所述第一横向侧相对并且从所述下部表面延伸到所述上部表面的第二横向侧,所述第二横向侧限定被配置成接收所述椎间盘移除工具的至少一部分的凹陷部。 16. The system according to claim 15, wherein said test comprises expandable and extending to the upper surface of the first lateral side opposite from the lower surface of the second lateral side, the second lateral side defining a recess configured to receive the disc portion of the at least a portion of the removal tool.
  17. 17.根据权利要求15所述的系统,其中所述下部部分在所述下部表面上包括至少一个负荷传感器,所述至少一个负荷传感器被设置在感测从所述椎体施加到所述可扩展试验物上的负荷的位置处,并且其中所述上下部表面上的至少一个负荷传感器被设置在感测从所述椎体施加到所述可扩展试验物上的负荷的位置处。 17. The system according to claim 15, wherein said lower portion comprises at least one load sensor on the lower surface, said at least one load sensor is disposed in the sensing is applied from the vertebral body to be extended at a position on the load test substance, and wherein the at least one load sensor on the top and bottom surface portion is disposed at a location sensing is applied from the vertebral body may be extended to the load on the test object.
  18. 18.根据权利要求17所述的系统,其中所述下部部分包括设置在所述下部部分的拐角近侧的至少四个负荷传感器,并且所述上部部分包括设置在所述上部部分的拐角近侧的至少四个负荷传感器。 18. The system according to claim 17, wherein said lower portion comprises at least four load sensor disposed proximal to a corner of the lower portion and said upper portion includes a corner in the upper portion of the proximal at least four load sensor.
  19. 19.根据权利要求15所述的系统,其中所述扩展装置包括具有相对螺纹螺杆部分的杆和通过螺纹配合至每个螺杆部分的楔形件,所述楔形件被设置成从所述上部部分扩展所述下部部分。 19. The system according to claim 15, wherein said expansion means comprises a screw having a threaded stem portion relative to the wedge member and the mating portion of each screw is threaded through the wedge member is arranged to extend from the upper portion said lower portion.
  20. 20.根据权利要求15所述的系统,其中所述扩展装置包括设置在所述下部部分与所述上部部分之间以从所述上部部分扩展所述下部部分的千斤顶系统。 20. The system according to claim 15, wherein said expansion means comprises a portion disposed between the lower and the upper portion from the upper portion to the lower portion of the extension jacking system.
  21. 21.根据权利要求15所述的系统,其中所述椎间盘移除工具包括: 远侧部分,所述远侧部分具有关节运动部分和椎间盘移除元件; 近侧部分,所述近侧部分具有手柄和被配置成使所述关节运动部分进行关节运动的控制装置;和轴,所述轴纵向地设置在所述远侧部分与所述近侧部分之间,其中所述轴被配置成被至少部分地接收在所述第一横向侧的所述凹陷部中。 21. The system according to claim 15, wherein said disc removing tool comprising: a distal portion, the distal portion having a disc portion and a removable articulation member; proximal portion, the proximal portion having a handle and is configured to cause the articulation portion of the articulation control means; and a shaft disposed longitudinally between said distal portion and said proximal portion, wherein the shaft is configured to be at least partially received in the first lateral side of the recesses.
  22. 22.根据权利要求21所述的系统,其中所述轴包括纵向突出部。 22. The system according to claim 21, wherein said shaft comprises a longitudinal protrusion.
  23. 23.根据权利要求22所述的系统,其中所述第一横向侧的所述凹陷部包括被配置成接收所述纵向突出部的沟槽。 23. The system according to claim 22, wherein said first lateral side of the recess portion includes a longitudinal groove arranged to receive the projecting portion.
  24. 24.根据权利要求21所述的系统,其中所述椎间盘移除元件包括切割元件。 24. The system according to claim 21, wherein said removable element comprises a cutting element disc.
CN 201580018230 2014-04-08 2015-04-08 Methods and devices for spinal correction CN106163455A (en)

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